From the Research
Daily cetirizine may slightly increase the risk of falls in elderly patients, but the risk is generally lower compared to older antihistamines. Cetirizine (Zyrtec) is a second-generation antihistamine that causes less sedation and cognitive impairment than first-generation antihistamines like diphenhydramine (Benadryl) 1. For elderly patients requiring antihistamine therapy, cetirizine at the standard dose of 10mg daily (or 5mg daily in those with renal impairment) is usually a safer option. However, some elderly individuals may still experience mild sedation, dizziness, or impaired coordination with cetirizine, which could potentially increase fall risk. These effects are typically most pronounced when first starting the medication and often diminish with continued use.
To minimize risk, elderly patients should consider:
- Starting with a lower dose (5mg daily)
- Taking the medication at bedtime rather than in the morning
- Avoiding alcohol consumption while using cetirizine
- Implementing standard fall prevention measures, such as exercise interventions, which have been shown to reduce falls in older adults 2 If an elderly patient experiences significant dizziness or sedation with cetirizine, alternatives like fexofenadine (Allegra) may be considered, as it has even less potential to cross the blood-brain barrier and cause central nervous system effects. It is essential to weigh the benefits of cetirizine against the potential risks and consider individual patient factors, such as renal function and concomitant medication use, when making treatment decisions 3.